[Coccygodynia: Case Reports and Literature]. / Coccygodynie: vlastní kazuistiky a prehled literatury.

Coccygodynia, or tailbone pain, is the most common in women after trauma (complicated childbirth, fall). This pain can be treated conservatively (by using analgesics, local injections, physiotherapy) or by surgical coccygectomy. In the presented article, a set of five female patients is evaluated, in whom, after the failing conservative therapy, coccygectomy was indicated for persistent coccygodynia. In all female patients, improvement of their clinical condition and alleviation of pain were reported. Coccygectomy has its place in the management of coccygodynia and in correctly chosen patients significant pain reduction can be expected. Key words: coccygodynia, coccyx, coccygectomy, trauma.

[Autologous cranioplasty with a bone flap preserved subcutaneously in the mesogastrium]. / Autologní kranioplastika deponovanou kostní ploténkou v podkozí mezogastria.

INTRODUCTION: Cranioplasty with autologous bone flap is indicated in patients who have undergone decompressive craniectomy. Although it is an elective procedure, literature data indicate complication rates of up to 30%. The aim of this paper is to present our experience with cranioplasty with the patients own bone flap stored subcutaneously in the mesogastrium. METHODS: We retrospectively analyzed a set of 92 patients who had undergone cranioplasty after decompressive craniectomy using autologous graft preserved subcutaneously in the mesogastrium. The patients were clinically and radiologically examined before the surgery, and six weeks and one year after surgery. We evaluated the incidence of acute complications - wound hematoma, and late complications - infection and bone resorption. The postoperative cosmetic effect and patient discomfort from the stored bone flap also constituted an important aspect. RESULTS: The frequency of complications in our study group was 25%. Late complications were the most common, occurring with a frequency of 13%. These were mainly resorption of the bone flap (4.3%) and infectious complications (4.3%). Acute complications occurred with a frequency of 10.9% in our patient group. The most serious complication was cerebral edema of unknown origin leading to death of the patient. Unsatisfactory cosmetic effect as well as discomfort at the site where the flap was stored occurred in two cases. CONCLUSIONS: Cranioplasty is associated with a higher risk of complications in comparison with other elective procedures. Nevertheless, we regard cranioplasty with subcutaneously preserved bone flap as an inexpensive and suitable alternative to cryopreservation or alloplastic materials.Key words: cranioplasty complications of cranioplasty autologous cranioplasty decompressive craniectomy.

[Percutaneous interspinous dynamic stabilization (in-space) in patients with degenerative disease of the lumbosacral spine - a prospective study]. / Perkutánní interspinózní dynamická stabilizace (In-Space) u nemocných s degenerativním onemocnením lumbosakrální pátere - prospektivní studie.

INTRODUCTION: Interspinous spacers are supposed to reduce the segmental extension with a decrease in the expansion of yellow ligaments into the spinal canal, thus avoiding the dynamic narrowing of the spinal canal and compression of nerve roots. The aim of this study was to evaluate clinical outcomes and post-operative complications during one year in patients mostly having suffered from spinal stenosis and treated by In-Space interspinous spacer (Synthes, USA). MATERIAL AND METHODS: A total of 25 patients aged between 25 and 73 (average age 52.6) years, including 18 males and 7 females, with degenerative disease of the lumbosacral spine were indicated for surgery and prospectively followed up. The patients were operated on under general anaesthesia in the prone position, using a minimally invasive lateral percutaneous approach, under fluoroscopic control. The ODI and VAS values as well as X- rays (Range Of Motion and Sagittal angle of the operated segment) 6 and 12 months after the surgery were compared to each other and to those before surgery. The results were statistically analyzed. RESULTS: The average ODI of the group was 47.2% before surgery and 17.48% 6 months (22.76% 12 months) after surgery, showing a statistically significant improvement by 63% (52% after 12 months). The average VAS of the group was 6.64 points before surgery and 2.96 points 6 months (2.8 points 12 months) after surgery, which showed a statistically significant improvement by 55.4% after 6 months (57.8% after 12 months) when compared to preoperative status. After surgery the lordotic sagittal angle remained in all cases; one year after surgery the angle increased due to the slight sinking of some implants. The extent of segmental motion was minimally changed (6.1° 6 months and 7.24° 12 months after surgery). No serious complications occurred. The effect of interspinous implants proved insufficient in two cases (one year and two years after surgery) and conversion to arthrodesis or decompression was performed. CONCLUSIONS: 1. Percutaneous, minimally invasive insertion of an In-Space interspinous spacer is an effective and safe method of dynamic stabilization not accompanied by any serious complications. 2. ODI improved by 63% 6 months after surgery with a decrease in this effect 12 months after surgery. VAS for axial and radicular pain, as reported by patients, improved on average by 55.4% 6 months and by 57.8% 12 months after surgery. 3. In all cases, the lordotic sagittal angle remained after surgery and the extent of segmental motion from flexion to extension was minimally changed.

[Combined approach to the treatment of severe aortic stenosis and to three coronary vessel diseases in patients with brain meningioma and severe stenosis of internal carotid artery]. / Kombinovaný prístup pri resení tezké aortální stenózy a onemocnení tri koronárních tepen u nemocného s mozkovým meningeomem a významnou stenózou pravé vnitrní krkavice.

The authors present a case report of a 76-year-old man with a simultaneous finding of severe aortic stenosis, three coronary vessel diseases, severe stenosis of internal carotid artery and brain meningioma. The patient was scheduled for carotid endarterectomy 2 months prior the aortic valve replacement and coronary artery bypass grafting. Brain meningioma was removed 3 months after the cardiac procedure. The authors present a successful interdisciplinary co-operation in the treatment strategy.